Nick C Levinsky1, Koffi Wima1, Mackenzie C Morris1, Syed A Ahmad2, Shimul A Shah1, Sandra L Starnes3, Robert M Van Haren4. 1. Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio. 2. Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Surgical Oncology, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio. 3. Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Thoracic Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio. 4. Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Thoracic Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio. Electronic address: vanharrm@ucmail.uc.edu.
Abstract
BACKGROUND: Salvage and delayed esophagectomy after chemoradiation therapy (CRT) have been associated with increased morbidity and mortality, but recent series have shown similar outcomes compared to timely esophagectomy. We aim to evaluate outcomes for delayed and salvage esophagectomy for esophageal adenocarcinoma utilizing a large national database. METHODS: The National Cancer Database for 2004 to 2014 was queried for patients with clinical stage II or III esophageal adenocarcinoma who underwent preoperative CRT and esophagectomy. Patients who underwent surgery <90 days after CRT were defined as the timely esophagectomy group (n = 7822), and those who underwent surgery ≥90 days after CRT were defined as the delayed esophagectomy group (n = 667). RESULTS: A total of 8489 patients met our inclusion criteria. The median post-CRT interval was 49 days (range, 40-61 days) for the timely esophagectomy group and 109 days (range, 97-132 days) for the delayed esophagectomy group. The delayed group was more likely to be of black race (2.3% vs 1.2%; P < .01) and more likely to have Medicare (47.9% vs 39.8%; P < .001). There were no significant between-group differences in chemotherapy regimens (P = .17), radiation dose (P = .18), or surgical approach (P = .48). The delayed esophagectomy group had higher rates of pathological complete response (22.2% vs 18.6%; P = .043) and 90-day postoperative mortality (10.4% vs 7.8%; P < .01). On multivariate analysis, delayed esophagectomy was not independently associated with decreased overall survival. CONCLUSIONS: In this large retrospective database study, despite increased perioperative mortality, delayed and salvage esophagectomy for adenocarcinoma appear to have similar long-term survival as timely esophagectomy. Delayed and salvage esophagectomy may be offered to patients who do not receive timely esophagectomy after CRT.
BACKGROUND: Salvage and delayed esophagectomy after chemoradiation therapy (CRT) have been associated with increased morbidity and mortality, but recent series have shown similar outcomes compared to timely esophagectomy. We aim to evaluate outcomes for delayed and salvage esophagectomy for esophageal adenocarcinoma utilizing a large national database. METHODS: The National Cancer Database for 2004 to 2014 was queried for patients with clinical stage II or III esophageal adenocarcinoma who underwent preoperative CRT and esophagectomy. Patients who underwent surgery <90 days after CRT were defined as the timely esophagectomy group (n = 7822), and those who underwent surgery ≥90 days after CRT were defined as the delayed esophagectomy group (n = 667). RESULTS: A total of 8489 patients met our inclusion criteria. The median post-CRT interval was 49 days (range, 40-61 days) for the timely esophagectomy group and 109 days (range, 97-132 days) for the delayed esophagectomy group. The delayed group was more likely to be of black race (2.3% vs 1.2%; P < .01) and more likely to have Medicare (47.9% vs 39.8%; P < .001). There were no significant between-group differences in chemotherapy regimens (P = .17), radiation dose (P = .18), or surgical approach (P = .48). The delayed esophagectomy group had higher rates of pathological complete response (22.2% vs 18.6%; P = .043) and 90-day postoperative mortality (10.4% vs 7.8%; P < .01). On multivariate analysis, delayed esophagectomy was not independently associated with decreased overall survival. CONCLUSIONS: In this large retrospective database study, despite increased perioperative mortality, delayed and salvage esophagectomy for adenocarcinoma appear to have similar long-term survival as timely esophagectomy. Delayed and salvage esophagectomy may be offered to patients who do not receive timely esophagectomy after CRT.
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Authors: Mara Antonoff; Leah Backhus; Daniel J Boffa; Stephen R Broderick; Lisa M Brown; Phillip Carrott; James M Clark; David Cooke; Elizabeth David; Matt Facktor; Farhood Farjah; Eric Grogan; James Isbell; David R Jones; Biniam Kidane; Anthony W Kim; Shaf Keshavjee; Seth Krantz; Natalie Lui; Linda Martin; Robert A Meguid; Shari L Meyerson; Tim Mullett; Heidi Nelson; David D Odell; Joseph D Phillips; Varun Puri; Valerie Rusch; Lawrence Shulman; Thomas K Varghese; Elliot Wakeam; Douglas E Wood Journal: Ann Thorac Surg Date: 2020-04-09 Impact factor: 4.330
Authors: Mara Antonoff; Leah Backhus; Daniel J Boffa; Stephen R Broderick; Lisa M Brown; Phillip Carrott; James M Clark; David Cooke; Elizabeth David; Matt Facktor; Farhood Farjah; Eric Grogan; James Isbell; David R Jones; Biniam Kidane; Anthony W Kim; Shaf Keshavjee; Seth Krantz; Natalie Lui; Linda Martin; Robert A Meguid; Shari L Meyerson; Tim Mullett; Heidi Nelson; David D Odell; Joseph D Phillips; Varun Puri; Valerie Rusch; Lawrence Shulman; Thomas K Varghese; Elliot Wakeam; Douglas E Wood Journal: J Thorac Cardiovasc Surg Date: 2020-04-09 Impact factor: 5.209
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